| Wilmot Dental Clinic | |
|
203 Mccomb St Wilmot AR 71676 | |
| (870) 473-2274 | |
| (870) 473-5392 |
| Full Name | Wilmot Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 203 Mccomb St, Wilmot, Arkansas |
| Authorized Official Name and Position | Gary Allan Nichols (CEO) |
| Authorized Official Contact | 8705385414 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilmot Dental Clinic Po Box 100 Portland AR 71663-0100 Ph: (870) 737-2737 | Wilmot Dental Clinic 203 Mccomb St Wilmot AR 71676 Ph: (870) 473-2274 |
| NPI Number | 1952405524 |
|---|---|
| Provider Enumeration Date | 09/12/2006 |
| Last Update Date | 06/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952405524 | NPI | - | NPPES |
| 112127631 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |